Limbal Transplantation in Ocular Surface Disease: Multicenter Retrospective Case Series Analysis

Abstract

Abstract: : Purpose: To report results of limbal transplantation (LT) in patients with limbal stem cell deficiency (LSCD) in the context of a variety of ocular surface diseases. Methods: A multicenter retrospective case series analysis of patients who underwent LT between 1996 and 2004 was performed. Data from 72 LT performed in 61 patients (65 eyes) were collected by the same researcher (JT) and using the same customized database (Microsoft Access 2000). Most LT were performed on recurrent pterygium (n=40), thermal and chemical burns (n=18), immune–mediated disorders (mucous membrane pemphigoid, Stevens–Johnson syndrome, rosacea–related, atopic keratoconjunctivitis) (n=7), iatrogenic (medical and surgical) (n=4), viral infection (n=2), and limbal neoplasia (n=1). Success was defined as an stable ocular surface, with no inflammation and no epithelial defects in an asymptomatic patient. Failure was the final result if at least one of the following was present: patient still symptomatic, epithelial instability, on–going inflammation or pterygium recurrence. Results:.There were 33 male and 28 females with a mean age of 55.8 years (SD: 15.6; range, 20–89). Mean follow–up was 19.8 months (SD 23.5; range, 3–115). Fifty eight (80.6%) LT were autografts (40 in pterygium, 12 in burns, 3 in iatrogenic, 2 in viral infection, 1 neoplasia) and 14 (19.4%) were allografts from cadaver (7 in immune–based disorders, 6 in burns, 1 iatrogenic); all these allografted patients received immunosuppression. Out of the total number of LT, 48 (66.7%) were successful. This proportion increased up to 81.0% (47/58) when autografts were used. However, only 7.1% (1/14) allografts survived. Conclusions: Autograft tissue for LT is always preferable over allografts to surgically treat LSCD, as survival is constantly higher, and systemic immunosuppression is avoided. As expected, immune–based disorders are the most difficult cases. LT has been preliminary shown to be an excellent option for recurrent pterygium, although prospective studies need to be performed to prove these results. .

Keywords: cornea: epithelium • transplantation • cornea: clinical science